Bayonne University Hospital

All Charges

Charge

Type

Setting

Price

HYDROXYZINE/50MG/TAB

Facility

$7.50

Service Code	NDC 51079081601
Hospital Charge Code	60633135
Hospital Revenue Code	250
Min. Negotiated Rate	$1.12
Max. Negotiated Rate	$1.12
Rate for Payer: Qualcare PPO/HMO/WC	$1.12

HYDROXYZINE ELX 10MG/5ML 60ML

Facility

$5.63

Service Code	NDC 60432015004
Hospital Charge Code	6002810
Hospital Revenue Code	251
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.81
Rate for Payer: Aetna Commercial	$2.14
Rate for Payer: Aetna Medicare Advantage	$1.69
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.44
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.44
Rate for Payer: Cigna Commercial	$2.81
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.69
Rate for Payer: Oxford Commercial	$1.13
Rate for Payer: Qualcare PPO/HMO/WC	$0.84
Rate for Payer: UnitedHealthcare Commercial	$1.13
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

HYDROXYZINE ELX 10MG/5ML 60ML

Facility

$5.63

Service Code	NDC 60432015004
Hospital Charge Code	6002810
Hospital Revenue Code	251
Min. Negotiated Rate	$0.84
Max. Negotiated Rate	$0.84
Rate for Payer: Qualcare PPO/HMO/WC	$0.84

HYDROXYZINE HCL 100MG/2ML INJ

Facility

$724.15

Hospital Charge Code	606350919
Hospital Revenue Code	636
Min. Negotiated Rate	$108.62
Max. Negotiated Rate	$175.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.24
Rate for Payer: Qualcare PPO/HMO/WC	$108.62

HYDROXYZINE HCL 100MG/2ML INJ

Facility

$724.15

Hospital Charge Code	606350919
Hospital Revenue Code	636
Min. Negotiated Rate	$17.45
Max. Negotiated Rate	$362.07
Rate for Payer: Aetna Commercial	$275.18
Rate for Payer: Aetna Medicare Advantage	$217.25
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$184.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$184.66
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$184.66
Rate for Payer: Cigna Commercial	$362.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$175.24
Rate for Payer: Qualcare PPO/HMO/WC	$108.62
Rate for Payer: UnitedHealthcare Community & State	$17.45
Rate for Payer: Wellpoint Medicaid Managed Care	$19.19

HYDROXYZINE INJ 100MG/2ML

Facility

$8.90

Hospital Charge Code	60627855
Hospital Revenue Code	636
Min. Negotiated Rate	$1.33
Max. Negotiated Rate	$2.15
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.33

HYDROXYZINE INJ 100MG/2ML

Facility

$8.90

Hospital Charge Code	60627855
Hospital Revenue Code	636
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.45
Rate for Payer: Aetna Commercial	$3.38
Rate for Payer: Aetna Medicare Advantage	$2.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$2.27
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$2.27
Rate for Payer: Cigna Commercial	$4.45
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$2.15
Rate for Payer: Qualcare PPO/HMO/WC	$1.33
Rate for Payer: UnitedHealthcare Community & State	$0.21
Rate for Payer: Wellpoint Medicaid Managed Care	$0.24

HYDROXYZINE PAMOATE/25MG

Facility

$3.00

Hospital Charge Code	60633138
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

HYDROXYZINE PAMOATE/25MG

Facility

$3.00

Hospital Charge Code	60633138
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE PAMOATE 25 MG CAP

Facility

$4.00

Service Code	NDC 51079007701
Hospital Charge Code	6022545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.60
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE PAMOATE 25 MG CAP

Facility

$4.00

Service Code	NDC 51079007701
Hospital Charge Code	6022545
Hospital Revenue Code	250
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.20
Rate for Payer: Oxford Commercial	$0.80
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Commercial	$0.80
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HYDROXYZINE PAMOATE/50MG

Facility

$4.00

Hospital Charge Code	60633136
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HYDROXYZINE PAMOATE/50MG

Facility

$3.00

Hospital Charge Code	60633137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.07
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$1.14
Rate for Payer: Aetna Medicare Advantage	$0.90
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$0.77
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$0.77
Rate for Payer: Cigna Commercial	$1.50
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45
Rate for Payer: UnitedHealthcare Community & State	$0.07
Rate for Payer: Wellpoint Medicaid Managed Care	$0.08

HYDROXYZINE PAMOATE/50MG

Facility

$4.00

Hospital Charge Code	60633136
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE PAMOATE/50MG

Facility

$3.00

Hospital Charge Code	60633137
Hospital Revenue Code	636
Min. Negotiated Rate	$0.45
Max. Negotiated Rate	$0.73
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.73
Rate for Payer: Qualcare PPO/HMO/WC	$0.45

HYDROXYZINE PAMOATE 50 MG CAP

Facility

$4.00

Service Code	HCPCS Q0177
Hospital Charge Code	60627231
Hospital Revenue Code	636
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$0.97
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60

HYDROXYZINE PAMOATE 50 MG CAP

Facility

$4.00

Service Code	HCPCS Q0177
Hospital Charge Code	60627231
Hospital Revenue Code	636
Min. Negotiated Rate	$0.10
Max. Negotiated Rate	$2.00
Rate for Payer: Aetna Commercial	$1.52
Rate for Payer: Aetna Medicare Advantage	$1.20
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.02
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.02
Rate for Payer: Cigna Commercial	$2.00
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$0.97
Rate for Payer: Qualcare PPO/HMO/WC	$0.60
Rate for Payer: UnitedHealthcare Community & State	$0.10
Rate for Payer: Wellpoint Medicaid Managed Care	$0.11

HYDROXYZINE SYRG 25MG/1ML

Facility

$162.14

Service Code	HCPCS J3410
Hospital Charge Code	60627857
Hospital Revenue Code	636
Min. Negotiated Rate	$3.91
Max. Negotiated Rate	$81.07
Rate for Payer: Aetna Commercial	$61.61
Rate for Payer: Aetna Medicare Advantage	$48.64
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$41.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$41.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$41.35
Rate for Payer: Cigna Commercial	$81.07
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.24
Rate for Payer: Qualcare PPO/HMO/WC	$24.32
Rate for Payer: UnitedHealthcare Community & State	$3.91
Rate for Payer: Wellpoint Medicaid Managed Care	$4.30

HYDROXYZINE SYRG 25MG/1ML

Facility

$162.14

Service Code	HCPCS J3410
Hospital Charge Code	60627857
Hospital Revenue Code	636
Min. Negotiated Rate	$24.32
Max. Negotiated Rate	$39.24
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$39.24
Rate for Payer: Qualcare PPO/HMO/WC	$24.32

HYDROXYZINE SYRG 50MG/1ML

Facility

$178.89

Service Code	HCPCS J3410
Hospital Charge Code	60627858
Hospital Revenue Code	636
Min. Negotiated Rate	$4.31
Max. Negotiated Rate	$89.44
Rate for Payer: Aetna Commercial	$67.98
Rate for Payer: Aetna Medicare Advantage	$53.67
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$45.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$45.62
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$45.62
Rate for Payer: Cigna Commercial	$89.44
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.83
Rate for Payer: UnitedHealthcare Community & State	$4.31
Rate for Payer: Wellpoint Medicaid Managed Care	$4.74

HYDROXYZINE SYRG 50MG/1ML

Facility

$178.89

Service Code	HCPCS J3410
Hospital Charge Code	60627858
Hospital Revenue Code	636
Min. Negotiated Rate	$26.83
Max. Negotiated Rate	$43.29
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$43.29
Rate for Payer: Qualcare PPO/HMO/WC	$26.83

HYDROXYZINE TUBEX

Facility

$4.50

Hospital Charge Code	6012645
Hospital Revenue Code	250
Min. Negotiated Rate	$0.68
Max. Negotiated Rate	$0.68
Rate for Payer: Qualcare PPO/HMO/WC	$0.68

HYDROXYZINE TUBEX

Facility

$4.50

Hospital Charge Code	6012645
Hospital Revenue Code	250
Min. Negotiated Rate	$0.11
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$1.71
Rate for Payer: Aetna Medicare Advantage	$1.35
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.15
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.15
Rate for Payer: Cigna Commercial	$2.25
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.35
Rate for Payer: Oxford Commercial	$0.90
Rate for Payer: Qualcare PPO/HMO/WC	$0.68
Rate for Payer: UnitedHealthcare Commercial	$0.90
Rate for Payer: UnitedHealthcare Community & State	$0.11
Rate for Payer: Wellpoint Medicaid Managed Care	$0.12

HYDROXYZINE TUBEX 50MG

Facility

$5.80

Hospital Charge Code	6012652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.14
Max. Negotiated Rate	$2.90
Rate for Payer: Aetna Commercial	$2.20
Rate for Payer: Aetna Medicare Advantage	$1.74
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Indemnity	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) Managed Care	$1.48
Rate for Payer: Blue Cross Blue Shield of New Jersey (Horizon) PPO	$1.48
Rate for Payer: Cigna Commercial	$2.90
Rate for Payer: MagnaCare PPO/Direct Plus/Exchange/WC	$1.74
Rate for Payer: Oxford Commercial	$1.16
Rate for Payer: Qualcare PPO/HMO/WC	$0.87
Rate for Payer: UnitedHealthcare Commercial	$1.16
Rate for Payer: UnitedHealthcare Community & State	$0.14
Rate for Payer: Wellpoint Medicaid Managed Care	$0.15

HYDROXYZINE TUBEX 50MG

Facility

$5.80

Hospital Charge Code	6012652
Hospital Revenue Code	250
Min. Negotiated Rate	$0.87
Max. Negotiated Rate	$0.87
Rate for Payer: Qualcare PPO/HMO/WC	$0.87

Know your out-of-pocket cost for care.

All Charges